Provider Demographics
NPI:1659355386
Name:PRUETTE, RALPH LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LYNN
Last Name:PRUETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CARTER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1992
Mailing Address - Country:US
Mailing Address - Phone:864-222-1970
Mailing Address - Fax:
Practice Address - Street 1:202 N MCDUFFIE ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5623
Practice Address - Country:US
Practice Address - Phone:864-225-7231
Practice Address - Fax:864-225-8999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist